Chapter 11

Case Study

1. What CUES do you recognize as important for planning Parker’s care?

Key cues include Parker’s history of schizophrenia, medication nonadherence, active auditory hallucinations, paranoia, and delusions, particularly involving food poisoning and fear of staff. His violent behavior that led to hospitalization, disheveled appearance, refusal to eat or shower, and tangential speech indicate he is experiencing an acute psychotic episode. He presents with guarded body language, poor eye contact, distractibility, and verbalizations suggesting persecutory delusions. His limited communication, mumbling, and bizarre statements all reflect disorganized thought processes. Additionally, he is isolative, withdrawn, and minimally responsive to staff efforts, indicating low insight and engagement. His refusal to participate in hygiene and nutritional intake further supports the need for intensive monitoring and a supportive, structured care approach.

2. What is your hypothesis for Parker based on this information?

Parker is currently experiencing an acute exacerbation of schizophrenia, marked by positive symptoms including hallucinations, delusions, paranoia, disorganized speech, and behavior. His decision to stop taking his medications likely contributed to this decompensation. He is at risk for self-neglect, malnutrition, and possible harm to self or others due to impaired perception of reality and inability to engage with care. His fear that staff are trying to poison him and his refusal to eat suggest impaired reality testing and a risk for physical health decline. His guardedness, agitation when questioned, and recent violent behavior also suggest a potential for unpredictable aggression if provoked or overstimulated.

3. Write a SMART goal for Parker based on his priority nursing problem at this time.

Parker will accept one meal or nutritional snack within the next 24 hours, with encouragement and staff support, as evidenced by consuming food or drink provided by the nursing team.

4. What are your priority nursing interventions for Parker?

The first priority is to ensure Parker’s safety and the safety of others by maintaining a calm, non-threatening environment and avoiding overstimulation. The nurse should use simple, non-confrontational communication and allow Parker space while encouraging small interactions to build trust. Establishing rapport by acknowledging his fear and offering reassurance without arguing about delusions is essential. Offering food or drink in sealed containers may help overcome his fear of poisoning. The nurse should collaborate with the interdisciplinary team to ensure medication adherence, assess for possible need for medication adjustments, and evaluate for signs of dehydration or malnutrition. Supportive interventions should include respecting his need for space while gently encouraging hygiene and routine. Using trauma-informed, person-centered care will help reduce agitation and promote cooperation.

5. How will you evaluate if your interventions have been effective?

Effectiveness will be evaluated by observing changes in Parker’s behavior, such as reduced agitation, increased willingness to communicate, acceptance of meals or snacks, and participation in basic care routines. Improvement may also be seen through more coherent speech, decreased hallucination-related behavior, and reduced paranoia over time. Consistent documentation of his responses to interventions, including verbal and non-verbal cues, is essential. Collaboration with the psychiatric provider will be important in evaluating medication effectiveness and overall mental status stabilization.

6. What symptoms require continued monitoring?

Ongoing monitoring is required for the presence and severity of auditory hallucinations, paranoid delusions, and disorganized thinking. Parker’s nutritional and hydration status should be closely watched, especially given his refusal to eat or drink. His hygiene habits, sleep patterns, and signs of escalating agitation or potential aggression are also important to monitor. Observing for signs of medication side effects or adverse reactions is critical, particularly as he begins or resumes psychotropic medications. Lastly, his insight into illness, engagement with staff, and overall functioning should be evaluated regularly to adjust the care plan as needed.

Answers to interactive elements are given within the interactive element.